Board Member Candidate

Interested in serving as a Board Member? Know someone who would make a great Board candidate? Simply complete the questionnaire and one of our team members will follow-up with you directly.

Please note: You must be a Manager or above to apply. Thank you.

Who is being nominated?*

I would like to nominate myself.
I would like to nominate another member.

How long have you/candidate been a member?*

1-2 years
3-5 years
6-10 years
More than 10 years

Candidate Name (First & Last)*

Candidate Daytime Phone Number*

Candidate Email Address*

Re-enter to confirm

What county do you work for?*

Which program(s) do you represent?*

Why do you feel you/this member would make a good Board Member? (please be as specific as possible)*

Please upload you/candidates resume as part of the application for Board review. Thank you.*

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